Anterior Chamber Bleeding After Laser Peripheral Iridotomy

Abstract

To our knowledge, this is the first study to describe the correlation of anterior chamber bleeding after laser peripheral iridotomy (LPI) and antiplatelet therapy.Objective: To determine the incidence and amount of anterior chamber bleeding after laser peripheral iridotomy in patients whose condition is suggestive of primary angle-closure glaucoma (PACS) who continued their antiplatelet or anticoagulant treatment before undergoing LPI compared with when they discontinued treatment.Design and Setting: A prospective controlled trial.Patients: Patients with suspected bilateral primary angleclosure and no other ocular disease who take antiplatelet or anticoagulant medications regularly (from January 2010-October 2011) were enrolled.Main Outcome and Measure: The incidence of anterior chamber bleeding with and without antiplatelet and anticoagulant therapy.Results: A total of 104 patients (208 eyes) participated in the study. Thirty-six eyes (34.6%) in the treated and untreated arms bled. The amount of bleeding did not differ significantly when the patient was on or off antiplatelet or anticoagulant treatment, nor did the immediate postprocedure mean intraocular pressure (P =.13). The type of antiplatelet or anticoagulant, total laser energy, age, sex, or color of irides were not risk factors for increased bleeding (P=.156 for all parameters). Conclusions:No indication was noted for discontinuing these medications before a high-powered pulsed laser peripheral iridotomy. METHODSThis was a prospective controlled trial with a split body design. Ethical approval was ob-

Resident-performed laser peripheral iridotomy in primary angle closure, primary angle closure suspects, and primary angle closure glaucoma

“…This trend was not found or examined in other studies. 4 – 8 Ethnicity was our surrogate for iris color, since iris color was not routinely recorded. Interestingly, when examining power usage by residency year for the various subtypes of angle closure, a significant decrease in mean energy use was observed in eyes with PAC only.…”

“…Complications include transient blurred vision, intraocular pressure (IOP) rise, dysphotopsia, hyphema, closure of the iridotomy and damage to other tissues. 1 , 2 , 4 While a number of studies have reported on the typical power use and complication rates among LPIs performed by attending and practicing ophthalmologists, 4 – 8 none have reported on the power use and complication rates among resident-performed LPIs. The purpose of this study was to evaluate resident-performed LPIs and compare power use and complication rates to published data for attending-performed LPIs.…”

Bilateral Same-day Laser Peripheral Iridotomy in the Philadelphia Glaucoma Detection and Treatment Project

“…Known complications of LPI include immediate IOP rise, 15 bleeding, 16 marked inflammation, 17 visual shadows, ghost images, crescents, lines, 18 cataract progression, 19 lens dislocation, 20 and other lens-related and cornea-related pathologies, including corneal decompensation. [21][22][23][24][25][26] Performing LPIs on 2 separate visits could possibly reduce the rate of complications occurring in both eyes simultaneously.…”

Effects of laser peripheral iridotomy on corneal endothelial cell density and cell morphology in primary angle closure suspect subjects

“…Thus, there is controversy regarding the safety of this procedure to the corneal endothelium, especially with respect to the relationship between laser peripheral iridotomy and corneal decompensation. [13141516] We assessed the effects of prophylactic laser peripheral iridotomy on corneal endothelial cell density, hexagonality, and CV in PACS eyes over a 12-month follow-up period. Our results revealed no decline in corneal endothelial cell density or alteration in cell morphology in the central, nasal, and temporal regions over the one-year follow-up period.…”